| NPI | 1821519349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: CA 105687) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: TX 32910) |
| Enumeration Date | 2017-07-06 |
| Last Update Date | 2020-11-19 |